Spongy appearance with sunburst calcification is seen in
Correct Answer: Serous cyst adenoma
Description: Serous cystadenoma-Serous cystadenomas (microcystic adenomas) are the second most common cystic tumours of the pancreas. The clinical presentation of serous cystadenomas is similar to that of mucinous cystic pancreatic tumours.- An association with VHL disease has been described.-Most patients present with nonspecific symptoms of vague abdominal pain or discomfo, but many have a palpable mass.- These tumours can be large, with a size of 1-25 cm. Because of increasing use of cross-sectional imaging, many of these tumours are detected as an incidental, asymptomatic finding.- On CT scans, sunburst central calcification in a spongy mass is pathognomonic of this tumour, but this finding occurs only in 10% of patients.- Endoscopic Ultrasonography (EUS) allows better resolution of the honeycomb structure than CT. At times, the cysts may be large, a feature that makes it difficult to differentiate these cysts from MCNs.g. Hypervascularity may be demonstrated on angiograms, and some tumours occur with intra-abdominal haemorrhage.-Analysis of the cyst fluid characteristically reveals low viscosity and low levels of CEA, with negative cytologic results for malignant cells, as the vast majority of serous cystadenomas are benign.-Surgical resection is the treatment of choice for symptomatic tumours and tumours that show continuous growth.-Many of these tumours may require a Whipple procedure or distal pancreatectomy, depending on the anatomic location. Distal pancreatectomy may be performed and the spleen can be preserved, given the absence of malignant potential.Mucinous cystic neoplasmsa. Nonenhanced CT scans show a well-defined, unilocular or multilocular, externally smooth, round-to-ovoid mass with fluid attenuation.b. The attenuation values of the multilocular cysts vary according to the degree of haemorrhage or protein in the mucoidc. Visualization of nodular or papillary excrescences with irregular borders of the septae is possible. If present, calcification is curvilinear or punctate and confined to the cyst wall or septa. Contrast-enhancedd. CT scans show enhancement of the cyst wall, internal septations, mural nodules, and other intracavitary projections. CT more clearly demonstrates the enhancement of cystic walls and septa than do other studies.e. Compared with serous cystic tumours, the cysts in MCNs are larger (>20 mm in diameter) and less numerous (usually <6).f. CT guided aspiration of the cyst can provide fuher diagnostic clues and enable their differentiation from other pancreatic cystic masses (eg, pseudocyst, serous cystadenoma, and solid and pseudopapillary neoplasm).g. MCN cyst fluid typically has a high viscosity, low amylase levels, and high CEA and carbohydrate antigen (CA) 72-4 levels, and they may show malignant cytology in patients with mucinous cystadenocarcinomas.h. Periodic acid Schiff (PAS) and May Grunwald/Giemsa (MGG) stains are usually positive for extracellular as well as intracellular mucin.i. Treatment is the same as that of serous cystadenoma.(REF. SCHWAZ SURGERY 8TH EDITION PG 1572; David Sutton; Textbook of radiology and imaging, 7th edition, page no.793 )
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